PubMed Health⌕ Search

Biomedical subjects

D A Sichel

Publications and source records attributed to D A Sichel.

8 recordsLinked to original sources
PubMed1996

Course of panic disorder during pregnancy and the puerperium: a preliminary study.

Pregnancy has been referred to as a time of well-being for patients with psychiatric disorder. However, this impression is derived primarily from anecdotal reports and retrospective studies, rather than systematic prospective evaluation. In this study, 10 pregnant women with previous histories of panic disorder were evaluated prospectively across pregnancy and the postpartum period using the Structured Clinical Interview for DSM-III-R and the Clinical Global Impression. Information regarding pharmacotherapy received was also recorded. Seven of 10 subjects continued to meet DSM-III-R criteria for panic disorder at all trimester visits. Symptoms persisted for some patients even in the context of treatment with antipanic medications. Most subjects (n = 9) met DSM-III-R criteria at 1-3 months postpartum despite nearly uniform intensification of antipanic treatment. Although some women may experience diminished symptoms of panic during pregnancy, in this sample most continued to experience panic attacks and to require antipanic treatment to control symptoms.

Adult↗
PubMed1995

Prophylactic estrogen in recurrent postpartum affective disorder.

Seven women with histories of puerperal psychosis and four with histories of puerperal major depression were consecutively treated with high-dose oral estrogen immediately following delivery. None of the women had histories of nonpuerperal affective disorder, and all women were affectively well throughout the current pregnancy and at delivery. Despite the high risk for recurrent illness in this population, only one woman developed relapse of postpartum affective disorder. All others remained entirely well and required no treatment with psychotropic medications during the 1 year follow-up period. This low rate of relapse, 9% compared to an expected 35-60% without prophylaxis, suggests that oral estrogen may stem the rapid rate of change in estrogen following delivery, thereby preventing the potential impact on dopaminergic and serotonergic neuroreceptors. It is hypothesized that the rapid rate of change of estrogen after delivery creates an "estrogen withdrawal state." This may be a critical factor in driving acute puerperal affective psychosis and early-onset puerperal major depression.

Administration, Oral↗
PubMed1995

Postpartum prophylaxis for women with bipolar disorder.

OBJECTIVE: The postpartum period has typically been considered a time of heightened vulnerability for development of affective disorders, and women with bipolar disorder have consistently demonstrated vulnerability to puerperal worsening of mood. This retrospective study examined the extent to which mood-stabilizing agents provide prophylactic benefit to bipolar women during the postpartum period. METHOD: The clinical course of 27 women meeting the DSM-III-R criteria for bipolar disorder was followed during pregnancy and the postpartum period. Information regarding severity of illness (as measured by number of episodes of mania, depression, or both) was obtained, in addition to data on pharmacotherapy (if any) received before, during, and after pregnancy. The extent to which the prophylactic use of antimanic agents minimized the risk of relapse was explored. RESULTS: Only one of the 14 patients taking prophylactic agents during the acute puerperium relapsed within the first 3 months postpartum, while eight of the 13 who did not receive antimanic drugs showed evidence of recurrent affective instability during those 3 months. A survival analysis indicated that the women receiving prophylactic treatment with mood stabilizers maintained well-being significantly longer than the women who did not receive such treatment. CONCLUSIONS: Women with bipolar disorder appear to benefit from puerperal prophylaxis with mood stabilizers. Consistent with results of earlier studies, postpartum prophylaxis was associated with lower rates of relapse into affective disorders. The findings have implications for the early identification and treatment of subgroups of women at particular risk for puerperal illness.

Adult↗
PubMed1994

Impact of pregnancy on panic disorder: a case series.

BACKGROUND: Pregnancy has a variable impact on the course of panic disorder. Some patients describe diminished anxiety symptoms during pregnancy, while others note persistence or worsening of symptoms. METHOD: We retrospectively evaluated the clinical course of 49 women with pregravid panic disorder across three trimesters of pregnancy and evaluated the extent to which severity of pregravid panic disorder predicted course of anxiety symptoms, medication received, and ability to discontinue medication during pregnancy. RESULTS: While 38 women (78%) were noted either to have insignificant change in status or to have clinical improvement, 10 women (20%) evinced more severe panic symptoms during pregnancy. More severely ill women received pharmacotherapeutic intervention during some portion of their pregnancy compared with less severely ill women. Pregnancy did not increase the likelihood of successful discontinuation from antipanic medication. CONCLUSION: Impact of pregnancy on panic disorder is variable. Some patients, particularly those with milder symptoms, may improve during this time; more severely ill women may constitute a subgroup at risk for persistence of underlying disease and with a need for continued treatment with antipanic medication.

Ambulatory Care↗
PubMed1994

Postpartum course in women with preexisting panic disorder.

BACKGROUND: The postpartum period has typically been considered a time of risk for development of psychiatric disorder. Impact of the postpartum period on the course of anxiety disorders has not been characterized. This report describes the postpartum clinical course of 40 nondepressed women with preexisting panic disorder who were followed during pregnancy and the puerperium. METHOD: Through chart review and interview, we retrospectively evaluated the clinical course during the postpartum period of 40 women with pregravid panic disorder. Severity of illness, along with treatment received, was assessed from the third trimester of pregnancy to the twelfth postpartum week. RESULTS: While 26 patients (65%) either maintained (N = 23) or improved (N = 3) clinical status, 14 patients (35%) demonstrated puerperal worsening. Those patients who received pharmacotherapy by Trimester 3 were significantly less likely to experience puerperal worsening of anxiety than those who did not receive treatment prior to the puerperium (p < .0001). CONCLUSION: The puerperium is a period of risk for some women with pregravid panic disorder. Antipanic medication may be prophylactic for those women at greatest risk.

Ambulatory Care↗
PubMed1993

Postpartum obsessive compulsive disorder: a case series.

BACKGROUND: The puerperium has typically been a period of risk for the development of psychiatric illness. Although postpartum depressive illness has been discussed extensively in the literature, obsessive compulsive disorder during pregnancy and puerperium has received little attention. METHOD: Fifteen women with new-onset obsessive compulsive symptoms during the puerperium were retrospectively evaluated by chart review; all met DSM-III-R criteria for obsessive compulsive disorder. Distinctive features of their clinical presentation, pharmacotherapy received, and status at 1-year follow-up were recorded. RESULTS: Patients were noted to have a characteristic constellation of symptoms comprised of disabling intrusive obsessional thoughts to harm their babies. Obsessive rituals were not observed in any of the patients described. Patients frequently developed secondary depression and appeared to be exquisitely responsive to serotonin selective reuptake inhibitors. CONCLUSION: The puerperium may be a period of risk for development of new-onset obsessive compulsive disorder. Clinicians caring for puerperal women need to be aware of the impact of these symptoms on maternal and fetal well-being.

Adult↗
PubMed1988

Postpartum panic disorder.

The literature on postpartum psychiatric disorders is limited to descriptions of depressive and/or psychotic syndromes. The authors describe three cases of panic disorder presenting for the first time in the early postpartum period. Clinicians should differentiate between postpartum panic disorder and the well-recognized presentation of postpartum depression.

Adult↗